Barriers and facilitators to oral PrEP uptake among high-risk men after HIV testing at workplaces in Uganda: a qualitative study

Abstract

Background Men in Uganda contribute significantly to new HIV infections annually yet PrEP uptake among them is low and those initiated are likely to discontinue usage. We explored the barriers and facilitators to PrEP uptake among high-risk men employed in private security services with negative HIV results after testing at workplaces in Uganda. Methods An explorative qualitative study comprising in-depth participant interviews. Data were collected via telephone calls and manually analyzed by inductive content analysis. Results Fifty-six (56) men participated, 27(48.21%) had heard about PrEP, and 29(51.79%) were willing to initiate it. Four categories emerged for the facilitators of PrEP uptake including the perceived need for HIV prevention, awareness creation, availability, and sexual freedom. Six categories emerged for the barriers to PrEP uptake. These were: Inaccessibility of PrEP services, Misinformation, Knowledge deficit, Medication-related barriers, Potential for increased risky sexual behavior, and Perceptions about PrEP use. Conclusion The findings suggest the need for healthcare providers to offer information regarding PrEP and HIV prevention services and mass sensitization campaigns to facilitate uptake. Participants recommend mass roll-out of PrEP to lower-level facilities and accessible pick-up points for men such as workplaces. The men also suggested the use of longer-acting PrEP modalities such as an injectable option or an option that is utilized specifically by the female partner. Finally, the stigma surrounding PrEP use could be reduced by the separation of PrEP and ART services at health facilities, or special pick-up days to reduce waiting times.

Awareness and Willingness to Use HIV Infection Pre-Exposure Prophylaxis among Rwandan Men Who Have Sex with Men: Findings from a Web-based Survey

“…A high level of PrEP awareness is an indication that public health campaigns aimed at HIV/AIDS prevention are working. Knowledgeable people are more likely to actively seek information, speak with medical professionals, and make informed choices, which could lead to an increase in the use of PrEP among populations that are at risk (33,34,35). This awareness also enables public health organizations to target educational campaigns effectively, directing resources to populations with lower awareness to promote equitable access to PrEP information and hence potential use.…”

Facilitators and barriers to community pharmacy PrEP delivery: a scoping review

“…Disproportionately low uptake has been observed in some regions and among some populations at elevated risk of acquiring HIV, such as trans individuals [ 9 ], cisgender women [ 10 , 11 ], young people [ 12 ] and people of Black African or Caribbean origin [ 13 , 14 ]. Low uptake has been attributed to several barriers in accessing PrEP, including the geographical proximity of PrEP providers, stigma and lack of client awareness of PrEP [ 15 ].…”

Systematic review of alternative HIV pre-exposure prophylaxis (PrEP) care delivery models to improve PrEP services

“…Such slow growth rate of PrEP uptake may be caused by low perception of HIV transmission risk, stigma from healthcare providers or family/friends, or lack of social support or awareness [5–7]. One of the major barriers to PrEP uptake is the lack of access to healthcare providers who are knowledgeable about and willing to prescribe PrEP [6,8]. More than one in eight PrEP-eligible gay, bisexual, and other men who have sex with men (MSM thereafter) live in a ‘PrEP desert’ [9], which is defined as requiring an hour or more round-trip drive to access PrEP services.…”

“…The Joint United Nations Programme on HIV/AIDS (UNAIDS) set a goal to increase the number of people taking oral PrEP globally to three millions by 2020, yet the goal was not achieved [4]. Such slow growth rate of PrEP uptake may be caused by low perception of HIV transmission risk, stigma from healthcare providers or family/friends, or lack of social support or awareness [5–7]. One of the major barriers to PrEP uptake is the lack of access to healthcare providers who are knowledgeable about and willing to prescribe PrEP [6,8].…”